What Drug Causes Most Hearing Impairment? Understanding Ototoxic Risks

October 11, 2025 •

3 min read

Over 200 medications are known to be ototoxic, with some causing temporary and others causing permanent hearing and balance issues. This guide helps answer what drug causes most hearing impairment by examining the specific types and associated risks of ototoxic medications.

Quick Summary

This article explores various medications, including chemotherapy agents, antibiotics, and analgesics, that can cause ototoxicity. It details how these drugs damage the inner ear, outlines key risk factors, and provides guidance on monitoring and mitigating potential hearing damage. The article clarifies why some drugs are considered highly ototoxic due to the severity or prevalence of their side effects.

Key Points

Ototoxicity Defined: Damage to the inner ear, including the cochlea (hearing) and vestibular system (balance), caused by medications.
Most Severe Culprits: Platinum-based chemotherapy drugs (e.g., cisplatin) and aminoglycoside antibiotics (e.g., gentamicin) cause the most severe, often permanent, hearing damage.
Widespread Prevalence: Common over-the-counter medications like NSAIDs and high-dose aspirin are prevalent causes of temporary tinnitus and hearing loss.
Risk Factors: Individual risk varies based on cumulative dose, duration, age, pre-existing conditions (e.g., renal failure), genetics, and the use of multiple ototoxic drugs.
Prevention and Monitoring: Awareness and regular hearing tests, especially for those on high-risk medications, are crucial for early detection and mitigation.
Reversibility: Damage from high-risk medications like cisplatin is typically irreversible, while effects from NSAIDs and loop diuretics are often temporary.
Symptoms of Ototoxicity: Key signs include new or worsening tinnitus, muffled hearing, a feeling of ear fullness, dizziness, or vertigo.

What is Ototoxicity?

Ototoxicity refers to the damaging effects of certain medications or chemicals on the inner ear, affecting both hearing (cochlea) and balance (vestibular system). Symptoms can include hearing loss, tinnitus, dizziness, or vertigo, and can be temporary or permanent. The degree of ototoxicity depends on factors such as the specific drug, dosage, treatment duration, and individual patient factors. While many drugs can cause ototoxicity, the question of what drug causes most hearing impairment depends on whether one considers the most severe effects or the most common ones.

The Most Damaging Drugs: Chemotherapy and Aminoglycosides

Drugs known for causing severe and permanent hearing damage are primarily platinum-based chemotherapy agents and aminoglycoside antibiotics. These are used for serious conditions, requiring a balance between their life-saving benefits and ototoxic risks.

Platinum-Based Chemotherapy Agents

Cisplatin and carboplatin, used in cancer treatment, have significant ototoxic potential. Cisplatin, in particular, is associated with permanent, dose-dependent ototoxicity. These drugs damage the inner ear's hair cells, leading to irreversible hearing loss. Risk is increased by higher doses, radiation to the head, and age.

Aminoglycoside Antibiotics

Aminoglycosides like gentamicin, amikacin, and streptomycin, used for serious bacterial infections, are highly ototoxic. They damage hair cells, resulting in permanent hearing or balance issues. Genetic mutations can increase susceptibility, causing rapid hearing loss. Some aminoglycosides primarily affect balance (vestibulotoxic), while others mainly affect hearing (cochleotoxic).

More Common Causes: Analgesics and Diuretics

Some commonly used medications also pose ototoxic risks, particularly with high or long-term doses. Due to their widespread use, they are a frequent, though often temporary, source of hearing problems.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Salicylates

High doses of aspirin and other NSAIDs can cause temporary tinnitus and hearing loss. This is thought to be due to reduced blood flow to the cochlea and damage to outer hair cells. Symptoms usually resolve after discontinuing the medication.

Loop Diuretics

Loop diuretics like furosemide and bumetanide can cause temporary hearing loss, especially at high intravenous doses or with poor kidney function. Their ototoxic effects are worsened when combined with other ototoxic drugs.

Comparing Ototoxic Medications

The table below summarizes key differences among some ototoxic drug classes.


Drug Class	Examples	Potential Effect	Nature of Damage	Key Risk Factor
Chemotherapy	Cisplatin, Carboplatin	High-frequency hearing loss, tinnitus	Permanent	Cumulative dose, age, radiation
Aminoglycoside Antibiotics	Gentamicin, Amikacin	Hearing loss, balance issues	Permanent	Renal insufficiency, genetic predisposition
NSAIDs and Salicylates	Aspirin, Ibuprofen	Tinnitus, temporary hearing loss	Reversible	High dose, frequent or long-term use
Loop Diuretics	Furosemide, Bumetanide	Temporary hearing loss	Reversible (usually)	High IV dose, kidney disease
Antidepressants	SSRIs, Tricyclics	Tinnitus, sudden hearing loss	Variable	Use of multiple drugs

Risk Factors and Monitoring

Several factors influence an individual's risk of ototoxicity. Higher doses, longer treatment duration, impaired kidney function, age (very young or elderly), genetics (like the 1555A>G mutation increasing sensitivity to aminoglycosides), and taking multiple ototoxic drugs all increase risk.

Monitoring and Prevention

Given that permanent damage is often irreversible, preventive measures are crucial. This includes obtaining a baseline hearing test before starting high-risk medications, if possible. Regular hearing tests during treatment are also recommended to monitor for changes. Patients should report any new symptoms like tinnitus, dizziness, or hearing changes to their healthcare provider immediately. Healthcare providers should aim for the lowest effective dose for the shortest duration, particularly for high-risk patients. Topical ear drops with ototoxic agents should be used cautiously if the eardrum is perforated.

Conclusion

Determining what drug causes most hearing impairment depends on whether one prioritizes the severity or prevalence of the effect. Platinum-based chemotherapy and aminoglycoside antibiotics pose the highest risk for severe, irreversible damage in individuals with serious illnesses. Conversely, common NSAIDs are a frequent source of temporary hearing issues due to widespread use. Awareness, open communication with healthcare providers, and monitoring for early signs are vital for managing ototoxicity risks and balancing treatment benefits against potential hearing damage. For further reading, an authoritative resource on the mechanisms of ototoxicity and potential protective strategies is available from PubMed Central: Mechanisms of Ototoxicity & Otoprotection - PubMed Central.

Signs and management of drug-induced ototoxicity

Symptoms: Watch for tinnitus, hearing loss, or balance problems.
High-risk drugs: Aminoglycoside antibiotics and cisplatin carry a high risk of severe and permanent damage.
Common but milder risks: NSAIDs and diuretics can cause temporary hearing issues, especially at high doses.
Early detection: Baseline and regular hearing tests are crucial for early identification.
Communication is key: Discuss all medications and existing hearing or balance issues with your doctor and pharmacist.

Frequently Asked Questions

Chemotherapy drugs like cisplatin and certain aminoglycoside antibiotics, such as gentamicin and amikacin, are most likely to cause permanent hearing loss, especially with higher cumulative doses and in susceptible individuals.

Yes, common pain relievers like NSAIDs (e.g., ibuprofen, naproxen) and high-dose aspirin can cause temporary hearing loss and tinnitus, particularly with frequent, long-term use. The symptoms usually resolve after stopping the medication.

Warning signs of ototoxicity include new or worsening tinnitus, muffled or distorted hearing, a feeling of fullness in the ears, and balance problems like dizziness or vertigo.

No. While damage from powerful drugs like cisplatin and aminoglycosides is often permanent, the effects from medications like aspirin, NSAIDs, and loop diuretics are often temporary and reversible once the drug is discontinued.

A doctor can monitor for ototoxicity by conducting baseline hearing tests before starting high-risk medication and performing regular follow-up audiometric tests during and after treatment to detect any changes.

Yes. Impaired kidney function is a significant risk factor for ototoxicity, particularly with drugs like aminoglycoside antibiotics and loop diuretics. Poor kidney clearance can cause the medication to build up to toxic levels in the body.

Yes, taking multiple ototoxic medications at the same time can have a synergistic effect, meaning the risk and severity of hearing loss are higher than the sum of the individual risks.

Topical antibiotic preparations containing potentially ototoxic agents, like neomycin or gentamicin, are generally considered safe for use in the outer ear if the eardrum is intact. However, if the eardrum is perforated, these drops should be used with caution and under medical supervision to avoid inner ear damage.